Duodopa

Debate between David Mowat and Glyn Davies

Tuesday 31st January 2017 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

It is a pleasure to serve under your chairmanship this afternoon, Sir Edward. I add my congratulations to those of my hon. Friend the Member for Montgomeryshire (Glyn Davies) to the hon. Member for Ealing, Southall (Mr Sharma) on securing the debate. It is right that we use the opportunity to discuss matters such as this one in Parliament and to ensure that we, whether that be NICE or the Department, get this right.

May I start by agreeing with the hon. Member for Ealing, Southall? He made the point that it would be completely wrong for NICE to make an evaluation based on flawed data, flawed information and a flawed methodology. If that were the case—we will talk about that during the next few minutes—it would require action. He also made the point that it is right that we have a body such as NICE that attempts to validate the treatments that are available in a coherent and consistent way.

The hon. Gentleman mentioned the quality-adjusted life year issue. There has to be a method of comparing drugs that are available, for example, for Parkinson’s with those available for cerebral palsy or muscular dystrophy, and we have to be fair to the community as a whole. That is what the NICE process is intended to do. It is also important to make the point that at the moment, the drug is available in NHS England. It has been commissioned since 2015 by the specialised commissioning team. That will continue—the updated NICE guidance will not change it—until NHS England’s specialised commissioning group makes a different decision, if that is what happens.

I will make a few points about Parkinson’s first of all. We know that it is a terrible, progressive disease and that there is no real understanding of what causes it. The occurrences of it are rising. Some 130,000 people in England have been diagnosed with Parkinson’s disease, which is caused by the death of a type of cell—those containing dopamine—in our brains. As the hon. Gentleman said, the disease causes tremors, stillness, slow movement, speech impediment and so on. Of those 130,000 people who are suffering from Parkinson’s disease, something like one in 1,500 are given Duodopa. There are currently 75 people in England who receive it, and the cost is roughly £28,000 for each of them.

The process is that when a diagnosis of Parkinson’s is made, NHS England typically refers the patient to a specialist centre for neurological care and an evaluation. A set of processes are carried out by the neurosurgeons in an attempt to remedy the dopamine issue that will have caused the Parkinson’s. The typical and main treatment is a drug called levodopa, but for a number of people there are side effects and it eventually stops working. As a follow-up remedy, as the hon. Gentleman said, either apomorphine, brain stimulation or Duodopa is prescribed, or a combination of those three things. How they interact with one another is quite complex, but those are the typical prescriptions if the main treatment is not successful.

As I said, the cost of Duodopa is something like £28,000 per patient per year, and 75 people are receiving it, so that is around £2 million a year, which is not massive in the great context of NHS spend. Nevertheless, it is important that we compare it with other treatments and make sure that it is the most effective for patients. That is what NICE has done. It had previous guidance on the treatment of Parkinson’s from 2006 and over the past year or so has produced draft guidelines, which the hon. Gentleman referred to, on the use of the drug. Those guidelines were put out to consultation, which closed in November. It is true, as the hon. Gentleman said, that those draft guidelines said that in NICE’s view, at no stage in the treatment is Duodopa to be recommended. The reason given was that, under NICE’s evaluation criteria, the cost of the drug is too high.

I have the NICE report in front of me, and the actual analysis is quite complex. The hon. Gentleman said that the report talks about the figure of £500,000—or alternatively £80,000, as I think I heard him say—per quality-assisted life year. I think it also comes up with lower numbers, but the truth is that it does not come up with a number that is anything close to the normal threshold at which a drug is approved for use, which is typically £20,000 to £25,000 per quality-assisted life year. The hon. Gentleman mentioned the methodology that was used. The consultation process drew in points from members of the public, from the profession and indeed from the company that markets the drug, which did say that there were methodology issues—I think it used the phrase “issues with the mathematics”. Those points will all be referred to the NICE committee and will be taken into account if and when the final analysis is confirmed or changed.

However, I will say that a quality-assisted life year figure in the order of £80,000 is quite a long way away from where it needs to be. There are various remedies for that. In similar debates I have made the point that one option is for the drugs companies involved to review their pricing. These things are not necessarily set in concrete. When they price a drug they are doing two things, and the cost of actually manufacturing the drug is often quite small compared with the invested intellectual capital that they are trying to recover. There is a choice, because if the drug is not prescribed they are not recovering either of those costs. I simply make the point that there is an opportunity for the company to do that.

As the hon. Gentleman said, it is true that NICE’s recommendation is that a combination of apomorphine and deep brain stimulation is more effective as a treatment and in terms of cost. We are having this debate on the draft guidance, and even if that guidance is confirmed, it will then have to go to the NHS England specialised commissioning group, which will have another opportunity to look at it in the round. As he said, Duodopa is a little unusual in that it is currently being prescribed. It is not as though it is a new treatment—it was prescribed in advance of the NICE recommendation.

I will say a little bit about NICE. It is very easy to knock it and say, “These guys don’t know what they’re doing. They don’t understand what is going on. It is obvious that if they were a bit more diligent or a bit better trained they would not have given this answer.” I looked at who was on the committee for the Parkinson’s guidelines. There were 18 people; it comprised consultant neurosurgeons, neurology pharmacists, people from patient groups and physiotherapists, so there were a number of people with a great deal of experience in managing Parkinson’s disease. It is important that the decisions on how we make drugs available are made by scientists, based on rigorous criteria and an attempt to look at the science rigorously, and not by Members of Parliament, as I think everybody in the Chamber would agree.

[Glyn Davies]

I intervene only to reinforce the Minister’s point. I remember being involved in campaigning against NICE and calling it out for everything I could when bowel cancer drugs were not available. That was driven by my personal interest, but in time I have come to realise—partly because my son who works for a drug company lectures me about this—that the principles behind NICE are absolutely vital. If we ever move away from that, we will finish up in a complete free-for-all, with all sorts of pressure and inducements from Members of Parliament not to follow proper procedure.

[David Mowat]

I can only concur that many of us benefit from lectures from our children, and it is nice to know that my hon. Friend does. I agree with the point made by the hon. Member for Ealing, Southall. If NICE has made a mistake, if something has been wrong in its analysis—this is why draft guidelines are published—and if things are brought to its attention that are not adequately reflected in its work, it has the opportunity to change that and will do so. Given the points that we have just heard, that is the right process.

When the finalised position is established, NHS England will consider whether to accept the NICE guidance. It will make a decision on what it does regarding the cohort that receive the drug and new patients, for whom there is potentially a difference in treatment. That process is many months away, frankly. It will not occur until NICE has finalised its guidance and published the complete position.

I finish by agreeing with the intervention made by my hon. Friend the Member for Montgomeryshire. These decisions are very difficult. Only 75 people receive the drug, but for them it is potentially life-changing, as it would be for the people who will need it in future, and I do not want to underestimate that. I can only repeat the points made in the NICE guidance; it believes that there are other equally effective treatments, such as a combination of apomorphine and brain stimulation. I am not a clinician, so it is not possible—and not right—for me to have a view on that, other than to say that until we are able to show that NICE has somehow been wrong in what it has done, it is right that we as a Parliament and as a group of MPs accept and respect that process, because we know that diligent scientists and clinicians have tried to get it right.

I thank the hon. Member for Ealing, Southall for raising this important subject; it is good that we have had the chance to talk about it today.

Question put and agreed to.

Electric and Low-emission Vehicles

Debate between David Mowat and Glyn Davies

Wednesday 15th June 2016 Westminster Hall

[Glyn Davies]

My hon. Friend is absolutely right. We do not know exactly what the future holds. We should use the term “ultra-low emission vehicles,” rather than “electric vehicles,” because hydrogen fuel cell technology may well develop quicker. Things change incredibly quickly. It is only five years since the companies starting producing electric cars. In another five years, who knows? Hydrogen fuel cells might be the future, but that technology requires massive infrastructure investment, too. Unless people can charge their car at a reasonable distance from home, the industry will not take off. That is one of the issues the Government face. There has to be an element of assessment of what the future will be, but having said that, we must be prepared for technology and invention taking us down a road that we had not wholly anticipated taking.

There are three points that I wish to raise with the Government; I am keen to hear the Minister’s response to them. First, I am not a natural regulator, or a person who would naturally support new licensing regimes; I would probably support the opposite approach. However, this is a massive industry. The IMI claims that by 2030 there will be a commercial and social benefit of £51 billion. I do not know how accurate that figure is, but clearly there will be a huge commercial benefit from what is going to happen. There is potential for a huge export business. All those things will happen, but we must have the safety and the technicians. Developing that side of the industry is important. It is not just about having the ability to manufacture cars; we also need the technicians to support that industry, and at the moment we just do not have them. We have to develop a system to deal with the safety aspects, and probably to help the development of a professionalism in working with these low-emission vehicles.

The Government might have to consider providing financial support, and they will certainly have to introduce a licensing system, because one death in an electric vehicle would clearly be massively tragic for the individual concerned and their family, and also tragic for the entire industry. A report of a death from an electric car on the front page of the Daily Mail would inflict a massive blow on an industry that I think will be hugely important to the future economy of our country.

The second issue is whether the Government should financially support a training industry. Again, I am not a natural supporter of Government intervention, through finance, in commercial markets, but the Government already support the development of the electric car industry. We offer grant support for the purchase of new vehicles, to reduce their price and to develop the industry, so I do not see any reason why we ought not to consider supporting the training infrastructure that is absolutely vital if the industry is to develop successfully. That is another issue that I would quite like to hear the Minister comment on.

The third issue is about the IMI. I have been very grateful for its advice and support; it makes a very strong argument on this issue, and that has informed some of the things that I have said this morning. I hope that the Minister would consider meeting the IMI to talk through the points that it makes very powerfully and persuasively. In my view, such a meeting would be very helpful, and I hope that the Minister is willing to agree to it.

[David Mowat (Warrington South) (Con)]

My hon. Friend is giving the Minister some good points to consider; I have a further point that he might wish to consider about this industry. In most EU countries, electric cars increase carbon emissions because of our current generating profile. As was rightly said, the fifth carbon budget is under consideration. Do we not need to be aware that this technology, at least for the next decade, will potentially increase carbon emissions in the UK and most parts of Europe?

[Glyn Davies]

I thank my hon. Friend for that intervention. That is a comment I have heard before. However, we are developing a completely new technology. The aim is lower emissions. We are trying to reach a decarbonisation target. Unless we achieve the aim of decarbonisation, this industry will not deliver what we want. However, I think that in the longer run, this is the route that we will go down. Practically, this is what is going to happen, and we need to take commercial advantage of this opportunity.

Oral Answers to Questions

Debate between David Mowat and Glyn Davies

Tuesday 6th May 2014 Commons Chamber

[Glyn Davies (Montgomeryshire) (Con)]

6. What his policy is on ensuring that legal aid is targeted at people with a strong connection to the UK.

[David Mowat (Warrington South) (Con)]

10. What his policy is on ensuring that legal aid is targeted at people with a strong connection to the UK.

Energy and Climate Change

Debate between David Mowat and Glyn Davies

Tuesday 20th December 2011 Commons Chamber

[David Mowat (Warrington South) (Con)]

Over the next few minutes, I shall give a critique of aspects of the Government’s energy policy, but first I thank the Government for having an energy policy that it is possible to critique. Although I do not want to make a party political point, it is worth reflecting on the legacy that we inherited. On renewables, we were 25th out of the 27 EU countries, in front of only Malta and Luxembourg. Some 90% of our energy is from gas, coal and oil; 2.5% is from renewables. Furthermore, in 2010—the last year for which figures are available—the percentage of our energy that came from renewables actually fell. That is a staggering achievement, and it is worth noting.

What the previous Government were able to do—they had some success in this—was pass legislation, some of which is important, and that is the basis of what I shall talk about today. The Climate Change Act 2008 requires us to reduce our emissions by 80% from a 1990 baseline. I will not argue about the basis for that; we have heard from the hon. Member for Brighton, Pavilion (Caroline Lucas) about the importance of the 2° C target. I agree with much of what she said on that, but as she is present I just make the point that if she, like George Monbiot, had accepted that nuclear power has a part to play in meeting the target, her speech would have had more resonance.

The Act places onerous requirements on us. Broadly speaking, reducing our use of carbon by 80% from a 1990 base requires a strategy that may embrace 25,000 wind turbines—I say that with some regret to my hon. Friend the Member for Montgomeryshire (Glyn Davies), who is sitting in front of me—and 25 nuclear power stations. Of course, it would also mean a massive reduction in energy use; I think that Members on both sides of the House would agree with that, and the green deal is a great way forward. My difficulty is with the next Act that the previous Government enacted, relating to the EU 20-20-20 directive of 2009, which requires us to produce 15% of our energy from renewables over the next decade. In my judgment, that directive contradicts our needs under the Climate Change Act 2008. We must decarbonise, and not necessarily go in for a renewables frenzy.

People might wonder why that matters, given that renewables need to be part of the mix. It matters because the emphasis on renewables has, in my judgment, meant that we have de-emphasised other low-carbon solutions that need to go ahead much more quickly, such as nuclear power and more use of gas, which I shall discuss.

One particular aspect of the renewables frenzy brought about by the 2009 directive undermines our ability to decarbonise, and we can see it in the solar power episode that is still playing out. We made a decision to pay 40p per unit for electricity that we can sell for 8p or 9p a unit. That, of course, generates a big industry. We make that subsidy even though we are no more than 2% or 3% of the global industry for solar, and therefore realistically cannot make a big difference to how the price comes down, and even though solar power produced through photovoltaics produces more than three times more carbon than nuclear power, as was shown in a recent peer-reviewed paper from Imperial college.

Why does all that matter? Why does it matter whether we go for renewables so hard, as opposed to going for gas, which is part of this? One of the things that we have to do is get our car and transport infrastructure off oil. We shall do that not just by electrifying, although that might be part of the solution, but by going down the route of gas cars. There are about 10 million gas cars in the world, more than 2 million of which are in Pakistan. There are nothing like that many electric cars. To say that gas is not part of the solution is just wrong.

[Glyn Davies]

Notwithstanding the fact that my hon. Friend is focused on putting too many wind farms in my constituency, I agree with much of what he says. Does he agree that we need to emphasise the potential of tidal power as well? I have not heard that mentioned a great deal. The Severn barrage can supply 5% of British energy needs. The potential of tidal power is massive.

[David Mowat]

I thank my hon. Friend for that intervention. I am not an expert in hydro power, the potential of which is very large. We have a deadline of 2017 to replace about a third of our generating capacity. To do that, we must use proven technology. That meant nuclear, but we might be late for that now. It is going to end up being gas, because gas is the default solution of a failure to invest in other technologies.

The very real need to decarbonise is being threatened by the costs that we are incurring through a strategy that is too focused on introducing the wrong sort of renewables too quickly. Let me give an example of the likely cost of the carbon floor. A £70 per tonne price of carbon will add about £400 to £500 to the average domestic bill. That is important because fuel poverty is at 10% now. We have energy-intensive industries laying off people or not investing in this country, in the context of trying to grow manufacturing as a percentage of GDP. The risk is that that will prevent some of the things that we need to do in pursuing decarbonisation. I ask the Government to consider this point: optimising renewables is not the same as optimising decarbonisation, and we need to do the latter.